Results from a patient survey to assess gastrointestinal burden of non-steroidal anti-inflammatory drug therapy contrasted with a review of data from EVA to determine satisfaction with rofecoxib

Non-steroidal anti-inflammatory drugs (NSAIDs) have frequently been linked with unpleasant gastrointestinal (GI) side-effects such as dyspepsia and ulcers. The present study investigated the burden of NSAID therapy from a patient perspective and also reviewed previously published data on satisfaction with a less gastrotoxic anti-inflammatory drug, rofecoxib. A questionnaire was sent to > 6000 members of the Norwegian Rheumatism Association requesting information on use and toxicity of NSAID therapy and requirements for supplementary gastroprotective and analgesic medication. The questionnaire confirmed a high incidence of NSAID use. About two-thirds of users changed brands of NSAIDs at least once, usually because of adverse effects and poor efficacy. Supplementary over-the-counter (OTC) and prescription analgesics were required by 72 and 59% of patients, respectively, while OTC and prescription gastroprotective agents to treat NSAID toxicity were required by 35 and 30%. This new patient-focused survey showed that treatment with conventional NSAIDs was unsatisfactory in terms of GI toxicity and sub-optimal pain relief. Reviewing EVA (Experience with VIOXX in Arthritis) data showed that there was a high level of approval for rofecoxib, with > 80% of 74,192 osteoarthritis (OA) patients expressing a preference for continuing such therapy. Preference for rofecoxib was significantly higher among patients with prior experience of conventional NSAIDs or other OA-specific medication. In EVA, the reduced GI toxicity of rofecoxib previously reported in other studies appeared to translate into a strong preference to continue this therapy in a large sample of patients. This is not surprising, given the poor satisfaction with NSAIDs highlighted by the Norwegian survey.